Biomedical subjects
Publications and source records attributed to U S Barzel.
Most hyperparathyroidism is subclinical, with no complaints of bone pain, constipation, mental confusion, or depression, no skeletal findings on x-ray, and no history of kidney stones. Routine hyperparathyroidectomy for asymptomatic hypercalcemia, with normal bone density and normal calciuria, particularly with moderate elevations of serum calcium, is now generally rejected.
Although the bone-sparing effect of estrogen replacement appears to be universal, osteoporosis does not develop in all women. Who should be treated, when, and for how long? Guidelines from available data are given. For women with established osteoporosis, estrogen therapy is definitely not appropriate, but a new multiple-agent protocol has shown promising results.
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The purpose of this study was to determine whether subclinical hypothyroidism, defined as the state in which there is an elevation of thyrotropin blood level (TSH) with a low-normal blood thyroxine level (T4), can be found in clinically healthy subjects. We identified, by screening of adults in an ambulatory patient care facility, 67 persons with T4 at the lower range of normal (4.5-6.0 micrograms/dL) who were free of acute nonthyroidal illness and who were not on medications known to affect T4, other than long term thyroxine therapy. TSH was determined in all 67 persons, whose ages ranged from 25 to 87 years. Nineteen persons in this population had a history of thyroid disease and 48 did not. Elevation of TSH was found in 13 subjects (19%), seven of whom had a history of thyroid disease. The prevalence of TSH elevation was 50% in those with T4 of 4.5- less than 5.0 micrograms/dL, 26% in those with T4 of 5.0-5.5 micrograms/dL, and 8% in those with T4 of greater than 5.5-6.0 micrograms/dL (p less than 0.02). Three of these 13 patients had been on thyroxine therapy at the time of the survey, and their thyroxine doses were adjusted, whereas five others were started on thyroxine therapy subsequent to the survey. Treatment doses as low as 0.05 mg/day increased the T4 and returned the TSH to normal in six patients. In two of five patients who went untreated, there was a substantial fall in T4 and/or a rise in TSH.(ABSTRACT TRUNCATED AT 250 WORDS)
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Osteoporosis affects approximately 15 to 20 million people in the United States and is the underlying cause of 1.3 million new fractures per year in people over age 45. The more common risk factors recognized in this disorder are older age, female sex, white race, physical inactivity, and early menopause. We now have available equipment which can measure bone density at various sites. These include single- and dual-photon densitometry, and single and dual quantitative computed tomography. These procedures are a quantum improvement over plain x-ray in the assessment of the severity of osteoporosis, but measurement at one site may not reflect the density at other sites. The value of these techniques in screening the general population for osteoporosis remains to be demonstrated. They are valuable when used to monitor patients longitudinally to assess the progression of disease and the effects of specific therapeutic regimens. There is no established effective therapy for osteoporosis so prevention is the goal. The effectiveness of different programs of physical activity in preventing bone loss and fractures is unknown but isotonic exercises three times a week for thirty minutes is recommended. There is general agreement that adequate calcium intake is important for maintenance of skeletal integrity, but there is no proof that a high dietary calcium alone will prevent osteoporosis. Estrogen therapy clearly prevents the accelerated bone loss which occurs in all white women at the time of menopause, but the question still remains who should be started on estrogens, and within what period of time after menopause are estrogens still useful in preventing postmenopausal bone loss, and for how long do we continue hormone therapy. Many questions are left to be answered but at least now osteoporosis is recognized as a major medical problem and much research is being done to answer the above questions.
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The records of 25 patients older than 75 years of age with the diagnosis of hyperthyroidism were reviewed. The mean age of the group (22 women and three men) was 81.5 years, the eldest being 95 years old. Twenty-one patients had Graves' disease, three had multinodular goiter, and one had toxic adenoma. Major presenting symptoms included weight loss (44 percent), palpitations (36 percent), and weakness (32 percent). The average number of thyrotoxic symptoms was only two per patient. Two patients were asymptomatic. Clinical signs included fine skin (40 percent), tremor (36 percent), atrial fibrillation (32 percent), and tachycardia (28 percent). The thyroid was palpable in only three patients with Graves' disease. Mean blood thyroxine level was 15.6 micrograms/dl (range, 11.5 to 24); blood triiodothyronine level was elevated in only half of the patients. One patient had triiodothyronine toxicosis. Mean 24-hour radioiodine uptake was 52 percent. Five patients had normal uptake. No correlation could be established between age, clinical symptoms, signs, and hormone blood levels. Because signs and symptoms of hyperthyroidism in the very old may be too subtle for clinical diagnosis, all elderly subjects should have periodic screening of blood thyroxine levels.
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Sarcoidosis, a granulomatous disease first recognized as a dermatologic disorder, is now known to involve multiple organs, including the eye. Indeed, ocular involvement may be the only clinical manifestation of this protean disease; it may involve any part of the visual apparatus and its adnexal structures. In this paper we report on the concurrence of sarcoidosis of the lid with Graves' ophthalmopathy in the same patient.
Elevation in the blood level of thyroid-stimulating hormone (thyrotropin) is the earliest and most sensitive manifestation of thyroidal failure, and is detectable in clinically healthy and apparently euthyroid persons. Oral thyroxine supplementation designed to titrate thyrotropin back to normal levels, and readjustment of the supplementary dose as failure of the gland progresses and thyrotropin level rises again, may prevent the emergence of clinical hypothyroidism.
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Levothyroxine (T4) replacement need in adults with primary hypothyroidism has recently been reported to fall with age. Previous studies have demonstrated that the resting metabolic rate falls with age in euthyroid adults and that this fall is proportional to a reduction in lean body mass (LBM). Since LBM is correlated also with 24-hour energy expenditure, this study examined the possibility that LBM might be an accurate predictor of T4 requirement. Seventy-five hypothyroid adults receiving full replacement therapy, ranging in age from 24 to 88 years, were studied retrospectively. Lean body mass was found to be a better predictor of T4 requirement than age or weight for the entire group as well as for subgroups of men and women 51 years old and older. The age-related reduction in LBM may be responsible for the reported decrease in the rate of fractional thyroxine degradation with age.
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